Outcomes after virologic failure of first-line ART in South Africa

To determine initial 24-week outcomes among prospectively enrolled patients with failure of initial antiretroviral therapy (ART). Baseline virologic failure was defined as HIV-1 viral load greater than 1000 copies/ml. Second-line ART was informed by results of genotype testing and selected from agents in the South-African public sector. Twenty-four week endpoints included virologic suppression and mortality. The cohort consisted of 141 patients (median CD4 cell count and viral load at failure of 173 cells/microl and 17 500 copies/ml). The median prior duration of initial ART was 12.0 months. At least one major resistance mutation was found in 87% of patients. After 24 weeks of follow-up, intent-to-treat virologic suppression (